Philly Gives Doctors Wide Leeway with Religious Exemption

The city of Philadelphia has adopted a new religious exemption policy that allows doctors with objections to certain kinds of care to opt out of their provision, raising questions about the quality of patient care at publicly funded clinics in the city.

Doris Fernandes, a long-time pediatrician with one of the city’s eight health clinics that serve low-income patients, sued the city in 2013, claiming that it fired her for refusing to comply with an initiative to promote the use of emergency contraceptives and long-acting contraceptives in adolescent populations at high risk for unintended pregnancy.

Fernandes, who is Catholic, told the city’s public health department that “participation is strictly forbidden by my religious beliefs and against my conscience,” reports Philadelphia magazine.

The city said that Fernandes was fired for refusing to refer patients who wanted contraceptives to another doctor, for her “lack of empathy,” and for telling one patient who had had an abortion that she had “committed murder.”

Under a settlement reached with the city, Fernandes will receive a “low-six figure” payment, and a new policy will allow providers with religious objections to “redirect” patients who ask for a given service to appropriate sources in a “nonjudgmental fashion.”

While the policy ensures that patients who ask about contraception will receive some type of referral, formal or not, it still falls far short of the current standard of care for adolescent patients. Both the American Academy of Pediatrics and the American Academy of Obstetricians and Gynecologists recommend that adolescent patients be counseled proactively about contraceptive use as part of routine exams, particularly about emergency contraceptives and long-acting reversible contraception (LARC), because of their potential to dramatically reduce teen pregnancy.

The AAP “encourage[s] routine counseling and advance emergency-contraception prescription as one part of a public health strategy to reduce teen pregnancy,” while ACOG now recommends “LARC methods should be first-line recommendations for all women and adolescents.”

It’s no coincidence that it’s exactly these two methods of contraception that Fernandes objected to most strenuously, as many on the religious right are now convinced that both EC and the most successful LARC method, the IUD, are abortifacients and, therefore, especially in need of religious exemption.

But it’s also no coincidence that these are the methods that give adolescents the most control over their sexuality and their futures, a control that doctors like Fernandes don’t want them to have in the name of religiously-informed beliefs about the proper role of women and sex.